Reviews & Analysis

Recent analyses from the FIELD randomized trial of fenofibrate in type 2 diabetes mellitus suggests that fibrates have beneficial effects and are safe in patients with moderate renal impairment. However, too few participants with chronic kidney disease were included in the study to provide reliable information.

Renal impairment is a common problem in patients with multiple myeloma. An early and rapid reduction in serum levels of free light chains (FLCs), achieved with the use of antimyeloma agents or direct removal of FLCs, has been shown to improve renal recovery in these patients. In this Review, the authors provide an update on new and current management approaches for reducing FLC levels in patients with myeloma-related acute kidney injury.

Use of peritoneal dialysis therapy, with or without newer 'biocompatible' peritoneal dialysis solutions, is associated with an improvement in patient survival that is equivalent to that obtained with hemodialysis. In this Review, the authors compare conventional and newer peritoneal dialysis solutions in terms of their documented impact on the peritoneum and effects such as removal of sodium and fluid, metabolic alterations, risk of cardiovascular disease and infections, and patient survival.

Glomerular hyperfiltration occurs as a physiological response during pregnancy and after consumption of high-protein meals, but an elevation in glomerular filtration rate is also associated with various disease states. In this Review, the authors discuss the definitions of glomerular hyperfiltration as well as the underlying mechanisms and hemodynamic changes that can adversely affect kidney function. They also describe potential approaches to treat glomerular hyperfiltration.

Accelerated cardiovascular disease is a major cause of death in patients with chronic kidney disease (CKD) and treatment with statin therapy is an important avenue for investigation. Here, Epstein and Vaziri discuss the pathogenesis of dyslipidemia in CKD and end-stage renal disease (ESRD), and examine the findings from three major clinical trials on statin therapy in patients with CKD and ESRD.

The combined effect of intensive glycemic and blood-pressure control on microvascular complications has been examined in an analysis of the ACCORD study. The investigators hypothesized that simultaneous intensive management would have an additive effect on outcomes; however, the results provide no evidence to support the combined intensive control of glycemia and blood pressure.

A recently published study on therapy for antineutrophil cytoplasmic autoantibody-associated small vessel vasculitis has provided answers but not clarity towards defining how best to treat patients with vasculitis. How do we use recent advances in knowledge to optimally influence our patients' outcomes without causing harm in the process?

Poor glycemic control is considered harmful in people with diabetes and chronic kidney disease; however, the ideal hemoglobin A_1c target continues to be elusive. What can we learn from new observational evidence published by Shurraw et al. in the Archives of Internal Medicine?

World Kidney Day on March 8, 2012 provides a chance to reflect on the success of kidney transplantation as a therapy for end-stage renal disease that surpasses dialysis treatments in terms of cost-effectiveness and improving quality and length of life.

Maintenance immunosuppressive drug therapy is necessary to counter the propensity of lupus nephritis to relapse. Claims that mycophenolate mofetil might be the magic bullet for both induction and maintenance therapies merit critical reappraisal due to inconsistent evidence of the superiority of mycophenolate mofetil over azathioprine, as well as its inordinately greater cost.

Revascularization alone might be sufficient to restore kidney function and regenerate the structure of the diseased kidney. In this Perspectives article, David Long, Jill Norman and Leon Fine provide an overview of how revascularization might be achieved using vascular growth factors or adoptive transfer of endothelial progenitor cells. The authors also describe how therapeutic strategies targeting the microvasculature could be enhanced in the future.

Protein–energy wasting (PEW) is an important risk factor for morbidity and mortality in patients on dialysis. Improving the poor nutritional status of patients with PEW on peritoneal dialysis is difficult owing to the multifactorial and complicated pathogenesis of PEW. This Review summarizes the nutritional issues regarding the causes, assessment and treatment of PEW, with a focus on patients receiving peritoneal dialysis.

Acute kidney injury (AKI) is a syndrome of decreased renal function that is associated with an increased risk of death. Studies from 2011, particularly in the field of AKI biomarkers, have provided important insights into the diagnosis, prognosis, and treatment of AKI. These advances are now being brought to the bedside to improve diagnosis and treatment of AKI.

A report has suggested a J-shaped association between estimated sodium excretion and cardiovascular risk. However, because spot urinary sodium does not reflect daily salt intake, the results from this study do not change the strong evidence showing that a modest reduction in salt intake has major beneficial effects on health.

Xerostomia is a common symptom in patients on chronic hemodialysis and is associated with a number of important clinical consequences that can have adverse effects on patients' daily activities and on the success of hemodialysis treatment. In this Review, Bossola and Tazza discuss the prevalence, pathogenesis, outcomes and available treatment options for this trying symptom.

Lupus nephritis is a complication of systemic lupus erythematosus, a heterogeneous autoimmune syndrome that involves multiple pathogenetic pathways. Here, Adriana Migliorini and Hans-Joachim Anders summarize accumulating data from the fields of genetics, clinical science, transcriptomics and basic immunology which indicate that antiviral immunity is involved in the pathogenesis of lupus nephritis. The authors also discuss the potential implications for innovative therapeutic strategies.

Renal biopsy analysis remains the best method to establish the cause of acute or chronic kidney allograft dysfunction. In this Review, Winfred Williams and colleagues provide an overview of the utility of performing kidney graft biopsies after transplantation. The wide variety of pathological features that characterize the major clinical diagnoses facing the clinician are also discussed. The authors also provide insights into emerging technologies that might expand our knowledge of the mechanisms of allograft dysfunction and the development of precise treatment protocols.